Enhancing ethical decision-making at the end-of-life: empowering conditions or team empowerment?

• Autor(a) principal: Hernández-Marrero, Pablo
• Data de Publicação: 2023
• Outros Autores: Pereira, Sandra Martins
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10400.14/41784

Background: Healthcare professionals are increasingly making end-of-life decisions (ELDs), which have become an integrated dimension of contemporary palliative and end-of-life care. ELDs are medical decisions made at the end of life that may have a potentially life-shortening effect. These situations are very often moments of high vulnerability with a profound impact on patients' ability to exercise their autonomy. Healthcare professionals perceive end-of-life decision-making as complex, difficult, and stressful. Evidence shows that making ELDs is frequently associated with burnout and moral distress. Strategies need to be implemented to enhance ethical decision-making at the end-of-life. Aim: To explore and discuss strategies on how to promote team empowerment within interdisciplinary teams to support and enhance ethical decision-making processes surrounded by uncertainty, risk, and asymmetry of information. Methods: This presentation is based on the work developed within project DELiCare: Decisions, Decision-making, and End-of-Life Care: Ethical Framework and Reasoning. The knowledge, experiences, and evidence from different fields will be mobilized and integrated to build theoretical and empirical frameworks. The structure and processes that can enhance ethico-clinical decision-making processes and their effectiveness in palliative and end-of-life care will be explored. Results: The need to make ELDs requires healthcare professionals and teams, as well as patients and family members, to embrace ethico-clinical decision-making processes under uncertainty, risk, and asymmetry of information. Shared decision-making is a cooperative process among healthcare professionals, patients, and families that enables a way of decision-making combining both the professionals’ expertise and the patient’s values, preferences, and goals. Shared decision-making processes should integrate information exchange, a deliberation period and making a decision. Communication among all stakeholders is paramount. Conclusions: Shared decision-making processes helps teams to bring together information and views, anticipate scenarios, and prepare a joint and common approach to the decision that needs to be made. This team empowering strategy fosters the sense of both individual and teamwork meaning, a core dimension of empowerment. By fostering shared decision-making processes, professionals and teams feel more empowered and are more effective in meeting patients’ values, wishes and preferences.